Study

▶ Cobicistat is predicted to increase the exposure to

fosaprepitant.oTheoretical

▶ Cobicistat

o

is predicted to increase the exposure to gefitinib.

Study

▶ Cobicistat

o

potentially increases the exposure to glecaprevir.

Theoretical

▶ Cobicistat is predicted to moderately to markedly increase the

exposure to grazoprevir. Avoid.rStudy

▶ Cobicistat is predicted to increase the exposure to guanfacine.

Adjust guanfacine dose, p. 352.oStudy

▶ Cobicistat is predicted to very markedly increase the exposure

to ibrutinib. Avoid potent inhibitors of CYP3A4 or adjust

ibrutinib dose, p. 983.rStudy

▶ Cobicistat

o

is predicted to increase the exposure to imatinib.

Study

▶ Cobicistat is predicted to increase the risk of toxicity when

given with irinotecan. Avoid.oStudy

▶ Cobicistat is predicted to increase the exposure to ivabradine.

Avoid.rStudy

▶ Cobicistat is predicted to increase the exposure to ivacaftor.

Adjust ivacaftor p. 293 or lumacaftor with ivacaftor p. 294 or

tezacaftor with ivacaftor p. 295 dose with potent inhibitors of

CYP3A4.rStudy

▶ Cobicistat is predicted to increase the exposure to lapatinib.

Avoid.oStudy

▶ Cobicistat is predicted to markedly increase the exposure to

lomitapide. Avoid.rStudy

▶ Cobicistat is predicted to increase the exposure to lurasidone.

Avoid.rStudy

▶ Cobicistat

o

is predicted to increase the exposure to macitentan.

Study

▶ Cobicistat markedly increases the exposure to maraviroc. Refer

to specialist literature.rStudy

▶ Cobicistat

r

potentially increases the exposure to mexiletine.

Theoretical

▶ Cobicistat is predicted to markedly to very markedly increase

the exposure to midazolam. Avoid or adjust dose.rStudy

▶ Cobicistat is predicted to very markedly increase the exposure

to midostaurin. Avoid or monitor for toxicity.rStudy

▶ Cobicistat is predicted to increase the exposure to mirabegron.

Adjust mirabegron dose in hepatic and renal impairment,

p. 781.oStudy

▶ Cobicistat

o

is predicted to increase the exposure to mirtazapine.

Study

▶ Mitotane is predicted to decrease the exposure to cobicistat.

Avoid.rTheoretical

▶ Cobicistat is predicted to increase the exposure to modafinil.

nTheoretical

▶ Cobicistat is predicted to increase the exposure to monoclonal

antibodies (trastuzumab emtansine). Avoid.rTheoretical

▶ Cobicistat is predicted to markedly increase the exposure to

naloxegol. Avoid.rStudy

▶ Cobicistat

o

is predicted to increase the exposure to netupitant.

Study

▶ Nevirapine is predicted to decrease the exposure to cobicistat.

Avoid.rTheoretical

▶ Cobicistat is predicted to moderately increase the exposure to

nilotinib. Avoid.rStudy

▶ Cobicistat is predicted to increase the exposure to nitisinone.

Adjust dose.oTheoretical

BNF 78 Cobicistat — Cobicistat 1431

Interactions | Appendix 1

A1

Cobicistat (continued)

▶ Cobicistat is predicted to increase the exposure to olaparib.

Avoid potent inhibitors of CYP3A4 or adjust olaparib dose,

p. 1005.oStudy

▶ Cobicistat is predicted to increase the exposure to opioids

(alfentanil, buprenorphine, fentanyl, oxycodone, sufentanil).

Monitor and adjust dose.rStudy

▶ Cobicistat is predicted to increase the exposure to ospemifene.

Avoid in poor CYP2C9 metabolisers.oStudy

▶ Cobicistat is predicted to increase the exposure to oxybutynin.

nStudy

▶ Cobicistat is predicted to increase the exposure to palbociclib.

Avoid or adjust palbociclib dose, p. 992.rStudy

▶ Cobicistat is predicted to increase the exposure to

panobinostat. Adjust panobinostat dose; in hepatic

impairment avoid, p. 936.oStudy

▶ Cobicistat is predicted to increase the exposure to paritaprevir.

Avoid.rStudy

▶ Cobicistat is predicted to increase the exposure to pazopanib.

Avoid or adjust pazopanib dose, p. 993.oStudy

▶ Cobicistat is predicted to increase the exposure to

r

phosphodiesterase type-5 inhibitors (avanafil, vardenafil). Avoid.

Study

▶ Cobicistat is predicted to increase the exposure to

phosphodiesterase type-5 inhibitors (sildenafil). Avoid potent

inhibitors of CYP3A4 or adjust

Study

sildenafil dose, p. 813.r

▶ Cobicistat is predicted to increase the exposure to

phosphodiesterase type-5 inhibitors (tadalafil). Use with caution

or avoid.rStudy

▶ Cobicistat is predicted to increase the exposure to pimozide.

Avoid.rStudy

▶ Cobicistat is predicted to slightly increase the exposure to

ponatinib

Study

. Monitor and adjust ponatinib dose, p. 994.o ▶ Cobicistat is predicted to moderately increase the exposure to

praziquantel.nStudy

▶ Cobicistat is predicted to increase the exposure to quetiapine.

Avoid.rStudy

▶ Cobicistat is predicted to increase the exposure to ranolazine.

Avoid.rStudy

▶ Cobicistat is predicted to increase the exposure to reboxetine.

Avoid.oStudy

▶ Cobicistat is predicted to increase the exposure to regorafenib.

Avoid.oStudy

▶ Cobicistat

o

is predicted to increase the exposure to repaglinide.

Study

▶ Cobicistat is predicted to increase the exposure to retinoids

(alitretinoin)

Theoretical

. Adjust alitretinoin dose, p. 1262.o ▶ Cobicistat is predicted to increase the exposure to ribociclib.

Avoid or adjust ribociclib dose, p. 997.oStudy

▶ Rifabutin decreases the concentration of cobicistat and

cobicistat increases the exposure to rifabutin. Avoid or adjust

dose.rStudy

▶ Rifampicin is predicted to decrease the exposure to cobicistat.

Avoid.rTheoretical

▶ Cobicistat is predicted to increase the exposure to risperidone.

Adjust dose.oStudy

▶ Cobicistat is predicted to increase the exposure to rivaroxaban.

Avoid.rTheoretical

▶ Cobicistat is predicted to increase the exposure to ruxolitinib.

Adjust dose and monitor side effects.oStudy

▶ Cobicistat

o

is predicted to increase the exposure to saxagliptin.

Study

▶ Cobicistat is predicted to increase the concentration of

sirolimus. Avoid.rStudy

▶ Cobicistat is predicted to increase the exposure to solifenacin.

Adjust solifenacin p. 779 or tamsulosin with solifenacin p. 786

dose; avoid in hepatic and renal impairment.rStudy

▶ Cobicistat is predicted to moderately increase the exposure to

SSRIs (dapoxetine). Avoid potent inhibitors of CYP3A4 or

adjust dapoxetine dose, p. 821.rStudy

▶ St John’s Wort is predicted to decrease the exposure to

cobicistat. Avoid.rTheoretical

▶ Cobicistat is predicted to increase the exposure to statins

(atorvastatin). Avoid or adjust dose and monitor

rhabdomyolysis.rStudy

▶ Cobicistat is predicted to increase the exposure to statins

(simvastatin). Avoid.rStudy

▶ Cobicistat is predicted to slightly increase the exposure to

sunitinib. Avoid or adjust sunitinib dose, p. 999.oStudy

▶ Cobicistat is predicted to increase the concentration of

tacrolimus. Monitor and adjust dose.rStudy

▶ Cobicistat is predicted to increase the exposure to taxanes

(cabazitaxel). Avoid.rStudy

▶ Cobicistat is predicted to moderately increase the exposure to

taxanes (docetaxel). Avoid or adjust dose.rStudy

▶ Cobicistat is predicted to increase the exposure to taxanes

(paclitaxel).rTheoretical

▶ Cobicistat is predicted to increase the concentration of

temsirolimus. Avoid.rTheoretical

▶ Cobicistat is predicted to increase the exposure to tezacaftor.

Adjust tezacaftor with ivacaftor p. 295 dose with potent

inhibitors of CYP3A4.rStudy

▶ Cobicistat is predicted to markedly increase the exposure to

ticagrelor. Avoid.rStudy

▶ Cobicistat is predicted to increase the exposure to tofacitinib.

Adjust tofacitinib dose, p. 1105.oStudy

▶ Cobicistat is predicted to increase the exposure to tolterodine.

Avoid.rStudy

▶ Cobicistat is predicted to increase the exposure to tolvaptan.

Manufacturer advises caution or adjust tolvaptan dose with

potent inhibitors of CYP3A4, p. 669.rStudy

▶ Cobicistat

o

is predicted to increase the exposure to toremifene.

Theoretical

▶ Cobicistat is predicted to increase the exposure to trabectedin.

Avoid or adjust dose.rTheoretical

▶ Cobicistat is predicted to moderately increase the exposure to

trazodone. Avoid or adjust dose.oStudy

▶ Cobicistat is predicted to slightly increase the exposure to

tricyclic antidepressants.nStudy

▶ Cobicistat is predicted to increase the exposure to ulipristal.

Avoid if used for uterine fibroids.rStudy

▶ Cobicistat is predicted to increase the exposure to

vemurafenib.rTheoretical

▶ Cobicistat is predicted to increase the exposure to venetoclax.

Avoid or adjust dose—consult product literature.rStudy

▶ Cobicistat

o

is predicted to increase the exposure to venlafaxine.

Study

▶ Cobicistat is predicted to increase the exposure to vinca

alkaloids.rTheoretical

▶ Cobicistat is predicted to increase the exposure to vitamin D

substances (paricalcitol).oStudy

▶ Cobicistat is predicted to increase the exposure to zopiclone.

Adjust dose.oTheoretical

Cobimetinib

▶ Antiarrhythmics (dronedarone) are predicted to increase the

exposure to cobimetinib.rTheoretical

▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,

phenytoin, primidone) are predicted to decrease the exposure

to cobimetinib. Avoid.rTheoretical

▶ Antifungals, azoles (fluconazole, isavuconazole, miconazole,

posaconazole) are predicted to increase the exposure to

cobimetinib.rTheoretical

▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are

predicted to markedly increase the exposure to cobimetinib.

Avoid or monitor for toxicity.rStudy

▶ Aprepitant is predicted to increase the exposure to

cobimetinib.rTheoretical

▶ Bosentan is predicted to decrease the exposure to cobimetinib.

Avoid.rTheoretical

▶ Calcium channel blockers (diltiazem, verapamil) are predicted to

increase the exposure to cobimetinib.rTheoretical

▶ Cobicistat is predicted to markedly increase the exposure to

cobimetinib. Avoid or monitor for toxicity.rStudy

▶ Crizotinib

r

is predicted to increase the exposure to cobimetinib.

Theoretical

▶ Efavirenz is predicted to decrease the exposure to cobimetinib.

Avoid.rTheoretical

1432 Cobicistat — Cobimetinib BNF 78

Interactions | Appendix 1

A1

▶ Enzalutamide is predicted to decrease the exposure to

cobimetinib. Avoid.rTheoretical

▶ Grapefruit juice is predicted to increase the exposure to

cobimetinib. Avoid.rTheoretical

▶ HIV-protease inhibitors are predicted to markedly increase the

exposure to

Study

cobimetinib. Avoid or monitor for toxicity.r

▶ Idelalisib is predicted to markedly increase the exposure to

cobimetinib. Avoid or monitor for toxicity.rStudy

▶ Imatinib

r

is predicted to increase the exposure to cobimetinib.

Theoretical

▶ Macrolides (clarithromycin) are predicted to markedly increase

the exposure to

r

cobimetinib. Avoid or monitor for toxicity.

Study

▶ Macrolides (erythromycin) are predicted to increase the

exposure to cobimetinib.rTheoretical

▶ Mitotane is predicted to decrease the exposure to cobimetinib.

Avoid.rTheoretical

▶ Netupitant is predicted to increase the exposure to

cobimetinib.rTheoretical

▶ Nevirapine is predicted to decrease the exposure to

cobimetinib. Avoid.rTheoretical

▶ Nilotinib

r

is predicted to increase the exposure to cobimetinib.

Theoretical

▶ Rifampicin is predicted to decrease the exposure to

cobimetinib. Avoid.rTheoretical

▶ St John’s Wort is predicted to decrease the exposure to

cobimetinib. Avoid.rTheoretical

Codeine → see opioids

Colchicine

▶ Antiarrhythmics (dronedarone) are predicted to increase the

exposure to colchicine. Adjust colchicine dose with moderate

inhibitors of CYP3A4, p. 1120.rStudy

▶ Antifungals, azoles (fluconazole, isavuconazole, posaconazole)

are predicted to increase the exposure to colchicine. Adjust

colchicine

r

dose with moderate inhibitors of CYP3A4, p. 1120.

Study

▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are

predicted to increase the exposure to colchicine. Avoid potent

inhibitors of CYP3A4 or adjust

Study

colchicine dose, p. 1120.r

▶ Apalutamide is predicted to decrease the exposure to

colchicine.nStudy

▶ Aprepitant is predicted to increase the exposure to colchicine.

Adjust colchicine dose with moderate inhibitors of CYP3A4,

p. 1120.rStudy

▶ Calcium channel blockers (diltiazem, verapamil) are predicted to

increase the exposure to colchicine. Adjust colchicine dose

with moderate inhibitors of CYP3A4, p. 1120.rStudy

▶ Ceritinib

o

is predicted to increase the exposure to colchicine.

Theoretical

▶ Ciclosporin increases the exposure to colchicine. Avoid or

adjust colchicine dose, p. 1120.rStudy

▶ Cobicistat is predicted to increase the exposure to colchicine.

Avoid potent inhibitors of CYP3A4 or adjust colchicine dose,

p. 1120.rStudy

▶ Crizotinib is predicted to increase the exposure to colchicine.

Adjust colchicine dose with moderate inhibitors of CYP3A4,

p. 1120.rStudy

▶ Eliglustat is predicted to increase the exposure to colchicine.

Avoid or adjust colchicine dose, p. 1120.rTheoretical

▶ Colchicine increases the risk of rhabdomyolysis when given

with fibrates.rAnecdotal

▶ HIV-protease inhibitors are predicted to increase the exposure

to colchicine. Avoid potent inhibitors of CYP3A4 or adjust

colchicine dose, p. 1120.rStudy

▶ Idelalisib is predicted to increase the exposure to colchicine.

Avoid potent inhibitors of CYP3A4 or adjust colchicine dose,

p. 1120.rStudy

▶ Imatinib is predicted to increase the exposure to colchicine.

Adjust colchicine dose with moderate inhibitors of CYP3A4,

p. 1120.rStudy

▶ Lapatinib is predicted to increase the exposure to colchicine.

Avoid or adjust colchicine dose, p. 1120.oTheoretical

▶ Macrolides (azithromycin) are predicted to increase the

r

exposure to colchicine. Avoid or adjust colchicine dose, p. 1120.

Theoretical

▶ Macrolides (clarithromycin) are predicted to increase the

exposure to colchicine. Avoid potent inhibitors of CYP3A4 or

adjust colchicine dose, p. 1120.rStudy

▶ Macrolides (erythromycin) are predicted to increase the

exposure to colchicine. Adjust colchicine dose with moderate

inhibitors of CYP3A4, p. 1120.rStudy

▶ Mirabegron is predicted to increase the exposure to colchicine.

nTheoretical

▶ Netupitant is predicted to increase the exposure to colchicine.

Adjust colchicine dose with moderate inhibitors of CYP3A4,

p. 1120.rStudy

▶ Nilotinib is predicted to increase the exposure to colchicine.

Adjust colchicine dose with moderate inhibitors of CYP3A4,

p. 1120.rStudy

▶ Pibrentasvir (with glecaprevir) is predicted to increase the

exposure to colchicine.oStudy

▶ Pitolisant is predicted to decrease the exposure to colchicine.

nTheoretical

▶ Ranolazine is predicted to increase the exposure to colchicine.

Avoid or adjust colchicine dose, p. 1120.rTheoretical

▶ Rolapitant

o

is predicted to increase the exposure to colchicine.

Study

▶ Colchicine increases the risk of rhabdomyolysis when given

with statins.rAnecdotal

▶ Velpatasvir

r

is predicted to increase the exposure to colchicine.

Theoretical

▶ Vemurafenib is predicted to increase the exposure to

colchicine

Theoretical

. Avoid or adjust colchicine dose, p. 1120.r

Colecalciferol → see vitamin D substances

Colesevelam

SEPARATION OF ADMINISTRATION Manufacturer advises take

4 hours before, or after, other drugs.

Colestipol

SEPARATION OF ADMINISTRATION Manufacturer advises take

other drugs at least 1 hour before, or 4 hours after, colestipol.

Colestyramine

SEPARATION OF ADMINISTRATION Manufacturer advises take

other drugs at least 1 hour before, or 4–6 hours after,

colestyramine.

Colistimethate → see TABLE 2 p. 1375 (nephrotoxicity), TABLE 20 p. 1379

(neuromuscular blocking effects)

Combined hormonal contraceptives

▶ Combined hormonal contraceptives are predicted to increase

the exposure to agomelatine.oStudy

▶ Combined hormonal contraceptives are predicted to increase

the exposure to

Theoretical

aminophylline. Adjust dose.o ▶ Combined hormonal contraceptives are predicted to increase

the exposure to anagrelide.oTheoretical

▶ Antiepileptics (carbamazepine, eslicarbazepine, fosphenytoin,

oxcarbazepine, perampanel, phenobarbital, phenytoin,

primidone, rufinamide, topiramate) are predicted to decrease

the efficacy of combined hormonal contraceptives. For FSRH

guidance, see Contraceptives, interactions p. 794.rStudy

▶ Combined hormonal contraceptives alter the exposure to

antiepileptics (lamotrigine). Adjust dose.oStudy

▶ Aprepitant is predicted to decrease the efficacy of combined

hormonal contraceptives. For FSRH guidance, see

Contraceptives, interactions p. 794.rStudy

▶ Bosentan is predicted to decrease the efficacy of combined

hormonal contraceptives. For FSRH guidance, see

Contraceptives, interactions p. 794.rStudy

▶ Brigatinib decreases the exposure to combined hormonal

contraceptives

r

. Use additional contraceptive precautions.

Theoretical

▶ Oral combined hormonal contraceptives potentially decrease

the ef

Theoretical

ficacy of chenodeoxycholic acid. Avoid.o

BNF 78 Cobimetinib — Combined hormonal contraceptives 1433

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